Phthalates linked to hundreds of thousands of heart disease deaths

Phthalates linked to hundreds of thousands of heart disease deaths

Daily exposure to certain chemicals used to make plastic household items may be linked to the more than 356,000 global deaths from heart disease that occurred in 2018 alone, a new analysis of population surveys shows.

Although the chemicals called phthalates are widely used worldwide, the Middle East, South Asia, East Asia and the Pacific accounted for a much larger share of the death toll than others - about three-quarters of the total.

For decades, experts have identified health concerns related to exposure to certain phthalates found in cosmetics, cleaning products, solvents, plastic pipes, insect repellents and other products. These chemicals break down into microscopic particles and are absorbed. Studies have linked such exposure to an increased risk of conditions ranging from obesity and diabetes to fertility problems and cancer.

Led by researchers at NYU Langone Health, the current study focused on a type of phthalate called di-2-ethylhexyl phthalate (DEHP), which is used to make food containers, medical devices and other plastic items softer and more flexible. Exposure has been shown in other studies to cause an overactive immune response (inflammation) in the heart's arteries, which over time is linked to an increased risk of heart attack or stroke. In their new analysis, the authors estimated that DEHP exposure contributed to 356,238 deaths, or more than 13 percent of all global heart disease mortality in 2018 among men and women ages 55 to 64.

By highlighting the link between phthalates and one of the world's leading causes of death, our findings add to the vast body of evidence that these chemicals pose an enormous threat to human health. “

Sara Hyman, BS, Study Guide Author, Associate Research Scientist, NYU Grossman School of Medicine

In a previous study from 2021, the research team linked more than 50,000 premature deaths per year, mostly from heart disease, among older Americans. Their latest research is believed to be the first global estimate of cardiovascular mortality - or, indeed, any health outcome - said Hyman, who is also a doctoral student at the NYU School of Global Public Health.

A report on the findings was published online April 29 in the JournalLancet Ebiomedicine.

For the research, the team used health and environmental data from dozens of population surveys to estimate DEHP exposure in 200 countries and territories. The information included urine samples that contained chemical breakdown products left behind by the plastic additive. The mortality data was compiled by the Institute for Health Metrics and Evaluation, a research group in the US that collects medical information worldwide to identify trends in public health.

Among key findings, the study showed that losses in the combined East Asia and Middle East region and in the combined East Asia and Pacific region accounted for approximately 42 percent and 32 percent of mortality from heart disease associated with DEHP, respectively. Notably, India had the highest death toll with 103,587 deaths, followed by China and Indonesia. The greater risk of cardiac death in these populations holds true even after the researchers adjusted their statistical analysis to take into account the population size within the age group studied.

One possible explanation, the authors say, is that these countries face higher exposure rates to the chemicals, perhaps because they have a boom in plastic production but fewer manufacturing restrictions than other regions.

“There is a clear disparity in which parts of the world bear the main risk of increased heart rate from phthalates,” said study senior author Leonardo Trasande, MD, MPP. “Our findings highlight the urgent need for global regulations to reduce exposure to these toxins, particularly in areas most affected by rapid industrialization and plastic consumption,” added Dr. Trasande, who affected Jim G. Hendrick, MD, professor of pediatrics at NYU Grossman School of Medicine.

Dr. Trasande, who is also a professor in the Ministry of Population Health, cautions that the analysis should not find that DEHP directly or alone caused heart disease and that higher risks of death did not take other types of phthalates into account. Nor did it include mortality among other age groups. As a result, the overall death toll from heart disease linked to these chemicals is likely much higher, he says.

According to Dr. Trasande's next researchers plan to track how reducing phthalate exposure over time affects global mortality rates and expand the study to other health concerns of the chemicals, such as premature babies. Dr. Trasande is also director of the Division of Environmental Pediatrics at NYU Grossman School of Medicine and the Center for the Study of Environmental Hazards.

Funding for the study was provided by National Institutes of Health Grant P2CES033423. Further study funding was provided from beyond petrochemicals.

Dr. Trasande has received support for travel or meetings from the Endocrine Society, the World Health Organization, the United Nations Environment Program, the Japanese ministries of environment and health, and the American Academy of Pediatrics. He has also received royalties and licenses from Houghton Mifflin Harcourt, Audible, Paidós and Kobunsha and has held leadership or trustee roles at BeautyCounter, Ahimsa, Braots Environmental Education and Footprint. None of these activities were related to the current study. The terms of all such relationships are managed by NYU Langone Health.

In addition to Hyman and Dr. Trasande, other NYU Langone researchers involved in the study are Jonathan Acevedo, MPH and Chiara Giannarelli, MD, PhD.

Sources: